Brian Hainline’s research while affiliated with National Athletic Trainers Association and other places

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Publications (88)


Surveillance of athlete mental health symptoms and disorders: a supplement to the International Olympic Committee's consensus statement on injury and illness surveillance Consensus statement
  • Article

July 2023

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174 Reads

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33 Citations

British Journal of Sports Medicine

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Abhinav Bindra

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In 2019, the International Olympic Committee (IOC) published a consensus statement outlining the principles for recording and reporting injury and illness in elite sport. The authors encouraged sport federations to adapt the framework to their sport-specific context. Since this publication, several sports have published extensions to the IOC consensus statement. In response to a paucity of epidemiological data on athlete mental health, the IOC mental health working group adapted the IOC consensus statement on injury and illness surveillance to improve the capturing of athlete mental health data. In addition to the members of the working group, other experts and athlete representatives joined the project team to address gaps in expertise, and to add stakeholder perspective, respectively. Following an in-person meeting, the authors worked remotely, applying the scientific literature on athlete mental health to the IOC injury and illness surveillance framework. A virtual meeting was held to reach consensus on final recommendations. Practical outcomes based on the analysis of the scientific literature are provided with respect to surveillance design, data collection and storage, data analysis and reporting of athlete mental health data. Mental health-specific report forms for athlete and health professional utilisation are included for both longitudinal and event-specific surveillance. Ultimately, this publication should encourage the standardisation of surveillance methodology for mental health symptoms and disorders among athletes, which will improve consistency in study designs, thus facilitating the pooling of data and comparison across studies. The goal is to encourage systematic surveillance of athlete mental health.



Figure 1 Methodology and process for the Sixth International Conference on Concussion in Sport and the Development of the Amsterdam 2022 Consensus Statement. CRT, Concussion Recognition Tool; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; SCAT6, Sport Concussion Assessment Tool-6; SCOAT6, Sport Concussion Office Assessment Tool-6; SRs, systematic reviews.
Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022
  • Article
  • Full-text available

June 2023

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508 Reads

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479 Citations

British Journal of Sports Medicine

For over two decades, the Concussion in Sport Group has held meetings and developed five international statements on concussion in sport. This 6th statement summarises the processes and outcomes of the 6th International Conference on Concussion in Sport held in Amsterdam on 27–30 October 2022 and should be read in conjunction with the (1) methodology paper that outlines the consensus process in detail and (2) 10 systematic reviews that informed the conference outcomes. Over 3½ years, author groups conducted systematic reviews of predetermined priority topics relevant to concussion in sport. The format of the conference, expert panel meetings and workshops to revise or develop new clinical assessment tools, as described in the methodology paper, evolved from previous consensus meetings with several new components. Apart from this consensus statement, the conference process yielded revised tools including the Concussion Recognition Tool-6 (CRT6) and Sport Concussion Assessment Tool-6 (SCAT6, Child SCAT6), as well as a new tool, the Sport Concussion Office Assessment Tool-6 (SCOAT6, Child SCOAT6). This consensus process also integrated new features including a focus on the para athlete, the athlete’s perspective, concussion-specific medical ethics and matters related to both athlete retirement and the potential long-term effects of SRC, including neurodegenerative disease. This statement summarises evidence-informed principles of concussion prevention, assessment and management, and emphasises those areas requiring more research.

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Structural and social determinants of mental health inequities among collegiate athletes during the COVID-19 pandemic

May 2023

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26 Reads

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2 Citations

British Journal of Sports Medicine

Objectives To characterise psychological distress during the COVID-19 pandemic among collegiate athletes and assess whether racial and ethnic differences in psychological distress are attenuated when accounting for inequitable exposure to structural and social determinants of health. Methods Participants were collegiate athletes on teams competing in the National Collegiate Athletic Association (n=24 246). An electronic questionnaire was distributed by email, open for completion 6 October to 2 November 2020. Multivariable linear regression models were used to assess the cross-sectional associations between meeting basic needs, death or hospitalisation due to COVID-19 of a close contact, race and ethnicity, and psychological distress. Results Athletes racialised as Black had higher levels of psychological distress than their white peers (B=0.36, 95% CI 0.08 to 0.64). Psychological distress was higher among athletes who had more difficulties meeting basic needs, and who had a close contact die or be hospitalised with COVID-19. After adjusting for these structural and social factors, Black athletes experienced less psychological distress than white peers (B=−0.27, 95% CI −0.54 to −0.01). Conclusions The present findings provide further evidence of how inequitable structural and social exposures are associated with racial and ethnic differences in mental health outcomes. Sports organisations should ensure the mental health services available for their athletes are appropriate for meeting the needs of individuals experiencing complex and traumatic stressors. Sports organisations should also consider whether there are opportunities to screen for social needs (eg, related to food or housing insecurity), and to connect athletes with resources to help meet those needs.


Improving inclusion and well-being of trans and gender nonconforming collegiate student-athletes: foundational concepts from the National Collegiate Athletic Association Summit on Gender Identity and Student-Athlete Participation

March 2023

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94 Reads

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5 Citations

British Journal of Sports Medicine

The National Collegiate Athletic Association (NCAA) Summit on Gender Identity and Student-Athlete Participation was convened to identify institutional/athletic department strategies that may support the well-being of trans and gender nonconforming (TGNC) collegiate student-athletes in the USA. The Summit's purview did not include policy-level changes to eligibility rules. A modified Delphi consensus process was used to identify strategies for supporting collegiate TGNC student-athlete well-being. Key steps included an exploration phase (learning, generating ideas), and an evaluation phase (rating ideas in terms of their utility and feasibility). Summit participants (n=60) included individuals meeting at least one of the following criteria: current or former TGNC athlete, academic or healthcare professional with topical expertise, collegiate athletics stakeholder who would be involved in implementing potential strategies, representative from leading sports medicine organisation, or representative from relevant NCAA membership committee. Summit participants identified strategies in the following domains: healthcare practices (patient-centred care and culturally sensitive care); education for all stakeholders involved in athletics; and administration (inclusive language, quality improvement processes). Summit participants also proposed ways that the NCAA, through its existing committee and governance structures, could help support the well-being of TGNC athletes. NCAA-focused concepts were in the following domains: policy making processes; eligibility and transfer processes; resource development and dissemination; and visibility and support for TGNC athletes. The strategies developed represent important and relevant approaches that member institutions, athletic departments, NCAA committees, governance bodies and other stakeholders might consider in their efforts to support TGNC student-athlete well-being.


Addressing mental health needs of NCAA student-athletes of colour: foundational concepts from the NCAA Summit on Diverse Student-Athlete Mental Health and Well-Being

September 2022

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101 Reads

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16 Citations

British Journal of Sports Medicine

We sought to identify concepts that may facilitate National Collegiate Athletic Association efforts to assist member institutions in addressing the mental health needs of student-athletes of colour. A two-step process was followed to generate and refine concepts, guided by Delphi methodology. First, a scoping review was conducted, including original peer-reviewed research articles that quantified or qualitatively described determinant(s) of racial or ethnic differences in athlete mental health or mental healthcare. Next, a multiday virtual meeting was facilitated to review the results of the scoping review, discuss lived experiences and generate potential concepts. Participants included a racially and ethnically diverse group of student-athletes, medical and mental health professionals, athletics administrators, diversity, equity and inclusion experts, health educators and representatives from leading organisations involved in athlete mental health. Through the consensus process, participants identified 42 concepts that member institutions might consider implementing on their campuses. Concepts were largely focused on organisational policies and practices such as staffing diversity and inclusion, expanded options for clinical support (ie, identity-relevant support groups) and within-organisation accountability. Concepts related to specific areas for stakeholder education were also identified. Institutions have the potential to play an important role in supporting the mental well being of student-athletes of colour, and the present concepts can help inform institutional action. While concepts proposed are believed to be broadly relevant across athletics settings, they would need to be further considered and tailored to reflect setting-specific organisational structures, resources and needs.


Differences in career longevity before and after implementation of the Women’s Tennis Association Tour Age Eligibility Rule and Player Development Programmes: a 25-year study

April 2022

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59 Reads

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4 Citations

British Journal of Sports Medicine

Objectives To assess differences in career longevity, as a potential marker of athlete well-being, before and after the 1995 implementation of the Women’s Tennis Association (WTA) Age Eligibility Rule (AER) and Player Development Programmes (PDP), which focused on organisational, physical and psychosocial education, skill building and support for adolescent athletes (≤17 years). Methods Career longevity data were collected through 2019 on adolescent players who began professional tournament play between 1970 and 2014 and reached a WTA singles ranking of 1–150 for a minimum of 1 week during their careers. Players were separated into pre-AER/PDP and post-AER/PDP groups, consisting of those who played their first professional events (FPE) before or after 1 January 1995. Measures of career longevity included career duration and premature retirement. Results Eight-hundred and eleven players were included in this study (51% pre-AER/PDP). The median career duration was 14.2 years for the post-AER/PDP group compared with 12.1 years for the pre-AER/PDP group (p<0.001). Moreover, post-AER/PDP players had higher probabilities of 10-year and 15-year careers compared with pre-AER/PDP players. After adjusting for age at FPE, athletes in the pre-AER/PDP group had an increased risk of shorter career duration (HR 1.55; 95% CI 1.31 to 1.83) and increased odds of premature retirement (OR 5.39; 95% CI 2.28 to 12.75) than athletes in the post-AER/PDP group. Conclusions Adolescent athletes participating on the WTA after the combined AER/PDP initiative had longer career durations, higher probabilities of 10-year and 15-year careers, and decreased risk of premature retirement compared with those participating prior to AER/PDP. Organisational practices that encompass both education and competition regulation can positively affect career longevity related to improving athlete well-being.


Sociodemographic characteristics, mental health, and substance use by athlete status (n=12,711)
Do varsity college athletes have a greater likelihood of risky alcohol and cannabis use than non-athletes? Results from a National Survey in Brazil

March 2022

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70 Reads

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2 Citations

Revista Brasileira de Psiquiatria

Objective: We examined the prevalence of risky alcohol and cannabis use among Brazilian varsity college athletes and whether this group had a greater likelihood of risky use than non-athletes. Methods: In 2009, Brazilian college students (n=12,711) were recruited for a national stratified random survey. Their sociodemographic characteristics, mental health, substance use, and participation in varsity sports were assessed. Binary logistic regression models were used to examine the association between varsity athlete status and moderate to high-risk alcohol and cannabis use. Results: Among varsity athletes, 67.6 and 10.7% reported risky alcohol and cannabis use, respectively. Varsity athletes had greater odds of risky alcohol consumption than non-athletes (aOR = 2.02, 95%CI 1.08-3.78). Varsity athletes also had greater odds of risky cannabis use than non-athletes in unadjusted analyses (OR = 2.57, 95%CI 1.05-6.28), although this relationship was attenuated after covariate adjustment. Conclusions: Among college students in Brazil, varsity athletes had a higher prevalence of risky alcohol and cannabis use than non-athletes. The rates were considerably higher than those observed among samples of U.S. college athletes. Future research should examine the use of these substances among varsity college athletes in other middle-income countries since these findings will likely guide prevention and treatment efforts.


Theory of planned behavior in the context of concussion reporting.²²
Study enrollment and randomization. CC, CrashCourse concussion education; CDC, Centers for Disease Control and Prevention video-based concussion education.
Changes in proxies of concussion-reporting intention after each educational intervention. Significance bars indicate significant differences for: all participants (black), the group randomized to receive CC-First (light red), the group randomized to receive CDC-First (light blue), immediately before and after each CC intervention (dark red), and immediately before and after each CDC intervention (blue). Error bars indicate 95% confidence intervals at each point. CC, CrashCourse concussion education; CDC, Centers for Disease Control and Prevention video-based concussion education.
Demographics and Characteristics of Study Participants
The Relationship between Concussion Education Administered at Each Time Point and Primary and Secondary Outcomes
Participating in Two Video Concussion Education Programs Sequentially Improves Concussion-Reporting Intention

December 2021

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87 Reads

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3 Citations

Undiagnosed concussions increase the risk of additional concussion and persistent symptoms from concussion. Because there are no reliable objective markers of concussion, self-reporting of subjective and non-visible symptoms are critical to ensuring proper concussion management. For this reason, educational interventions target concussion reporting, but the majority of studies have examined the efficacy of single educational interventions or compared interventions to one another. This randomized crossover study sought to identify whether there was benefit to administering multiple concussion education programs in tandem, back to back. The study randomized 313 male high school football players to first receive CrashCourse concussion education (CC) or Centers for Disease Control and Prevention video concussion education (CDC) followed by crossover with the other education. Athlete concussion-reporting intention, attitudes, subjective norms, perceived behavioral control, and enjoyment of education were assessed at baseline and after each intervention. There were statistically significant improvements across all measures, both after single intervention and crossover (all p < 0.001). Secondary analyses examining differences between education found that athletes reported higher enjoyment of concussion education immediately after participating in CC, as compared to CDC (p < 0.001). These findings demonstrate an additive benefit to implementing CC and CDC education in tandem, without decrement in enjoyment of concussion education after experiencing dual educations; in fact, enjoyment of concussion education improved after receiving education programs back to back. These educational programs appear to complement one another, and the results support the use of multi-modal concussion education to differentially target and maximize concussion reporting.



Citations (80)


... Definitions of injury and illness were derived according to the 2020 International Olympic Committee (IOC) Consensus Statement for recording and reporting sport epidemiological data. 13 The Orchard Sports Injury and Illness Classification System (OSIICS) 14 was used to classify all injuries and illnesses. Specifically, an injury was defined as ''tissue damage or other derangement of normal physical function due to participation in sports, resulting from rapid or repetitive transfer of kinetic energy.'' ...

Reference:

Comparative Analysis of Injury and Illness Rates Among Team USA Athletes at the Tokyo 2020 Summer Olympic and Paralympic Games
Surveillance of athlete mental health symptoms and disorders: a supplement to the International Olympic Committee's consensus statement on injury and illness surveillance Consensus statement
  • Citing Article
  • July 2023

British Journal of Sports Medicine

... Behavioral and psychological interventions are the mainstay of treatment for sport-related performance anxiety. There is no evidence-based guidance specifically for the use of psychopharmacologic drugs for the treatment of sportrelated performance anxiety (66). Furthermore, the potential for side effects may make athletes more likely to first pursue behavioral treatments over medication (33). ...

Anxiety Disorders in Athletes
  • Citing Article
  • July 2023

Clinics in Sports Medicine

... We consider that it is necessary and of great importance to have specific reference values of the study population for a correct interpretation of the test results. The recommendations of the latest consensus on concussion in sports highlighted, on one hand, the lack of studies in populations outside Anglo-Saxon countries with different cultural contexts, and on the other hand, the lack of information comparing SCAT data between genders [1]. To our knowledge, there are no studies that evaluate baseline SCAT values in the Hispanic community or non-professional rugby players of both sexes, so the reference values of professional players have usually been used in the treatment of concussion in these categories. ...

Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022

British Journal of Sports Medicine

... • Mental health risk and protective factors occur across settings and over time. Every student-athlete enters the college sport environment with different resiliencies and vulnerabilities because of different individual, family, community and societal experiences and exposures over the course of their life 1,[5][6][7][11][12][13][14][15] . While data from the 2022 ACHA-NCHA survey suggests collegiate sport participation may be a possible protective factor for mental health, student-athletes continue to report mental health concerns 16 . ...

Structural and social determinants of mental health inequities among collegiate athletes during the COVID-19 pandemic
  • Citing Article
  • May 2023

British Journal of Sports Medicine

... Women-identifying, transgender, and nonbinary athletes face unique pressures in the face of a male-dominated sport context that values highly masculine traits [14,15]. Additionally, because men have historically been the gatekeepers to sport, most resources developed for athletes have been developed with cisgender men, including mental health interventions used to increase athlete well-being. ...

Improving inclusion and well-being of trans and gender nonconforming collegiate student-athletes: foundational concepts from the National Collegiate Athletic Association Summit on Gender Identity and Student-Athlete Participation
  • Citing Article
  • March 2023

British Journal of Sports Medicine

... 46 The NCAA Summit on Diverse Student-Athlete Mental Health and Well-Being (2023) identified several areas for improvement of service provision and quality for minority athletes including: stakeholder education, screening, staffing, transition from sport, clinical care, reporting discrimination, communication, health care practices and personnel training, staff hiring and retention, coaches training, and working with families of student-athletes. 47 Are My Athletes At-Risk for Suicide? ...

Addressing mental health needs of NCAA student-athletes of colour: foundational concepts from the NCAA Summit on Diverse Student-Athlete Mental Health and Well-Being
  • Citing Article
  • September 2022

British Journal of Sports Medicine

... These feelings can upset their mental health, and how well they perform in their job. Research by Otis and others (2022) [24] , shows age manipulation can change a referee's career future. They can face penalties or bans which harm their chances of moving forward. ...

Differences in career longevity before and after implementation of the Women’s Tennis Association Tour Age Eligibility Rule and Player Development Programmes: a 25-year study
  • Citing Article
  • April 2022

British Journal of Sports Medicine

... Ingerir cannabis reduce los niveles de síntesis de dopamina estriatal y se relaciona con déficits de la función ejecutiva y disminución sinérgica de la dopamina, ocasionando una exacerbación del déficit cognitivo asociado con el trastorno por déficit de atención o con el propio uso de cannabis. Del mismo modo, el consumo de cannabis conlleva al uso de otras drogas, lo que a su vez ocasiona un aumento de los síntomas de alteración por déficit de atención (Mannes, 2022). ...

Do varsity college athletes have a greater likelihood of risky alcohol and cannabis use than non-athletes? Results from a National Survey in Brazil

Revista Brasileira de Psiquiatria

... As a result, when a concussion is suspected, modern concussion protocols mandate immediate removal from play or immediate assessment [4][5][6][7]. Education initiatives have also aimed to promote the early identification of these injuries to improve triage for appropriate management [8][9][10][11][12]. ...

Participating in Two Video Concussion Education Programs Sequentially Improves Concussion-Reporting Intention